University of Tokyo, Tokyo, Japan
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Lung Cancer III
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
PURPOSE: Talc is generally recognized as the agent of choice for pleurodesis. However, although uncommon, acute respiratory failure is a serious complication. Previous studies showed that smaller particles and higher doses of talc might increase the risk of acute respiratory failure. In the present study, we sought to determine the risk factors related to development of talc-induced acute respiratory failure.
METHODS: All patients who used sterile, large-particle size talc (Unitalc/Steritalc®) between August 2014 and January 2016 underwent review. Medical records at the University of Tokyo Hospital were analyzed to identify patients who underwent pleurodesis. Diagnosis of talc-induced acute respiratory failure was made based on oxygen levels and CT findings. Patient characteristics and clinical courses were analyzed.
RESULTS: During the 18 month period, 25 subjects underwent 27 talc pleurodesis. Diagnoses included lung adenocarcinoma (12; 44%), lung squamous cell carcinoma (4; 15%), sarcoma (3; 11%), and pneumothorax (2; 7%). Four (15%) developed acute respiratory failure after talc pleurodesis, and three of them died within 30 days. Among those without acute respiratory failure, only one (5%) died within 30 days. Acute respiratory failure developed 3.3±2.3 days after pleurodesis. Subjects with acute respiratory failure were significantly older than those without (81±2.6 vs 66±11.8; p<0.05). Performance status tended to be poorer in patients with acute respiratory failure (2.3±1.0 vs 1.4±0.8; p=0.07) but did not reach statistical significance. Prevalence of interstitial pneumonitis was higher among those with acute respiratory failure than those without (2/4 vs 1/21).
CONCLUSIONS: Age and performance status may be risk factors for acute respiratory failure in patients undergoing pleurodesis even with sterile, large-particle size talc.
CLINICAL IMPLICATIONS: It may be safer to avoid talc pleurodesis in older, frail patients.
DISCLOSURE: The following authors have nothing to disclose: Yuki Shinno, Hidenori Kage, Haruka Chino, Atsushi Inaba, Sayaka Arakawa, Satoshi Noguchi, Yosuke Amano, Yasuhiro Yamauchi, Goh Tanaka, Takahide Nagase
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